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Let's face it: Labor hurts. And how could it not? Your uterus will have to rhythmically squeeze your baby down toward the birth canal, and then your baby's head will have to push its way through your cervix and out your vagina (yes — out that same tiny opening that you once thought was too small to fit a tampon). Plenty of gain (you get a baby when you're done), but also, plenty of pain. But although women have lived to tell the tale of childbirth since time began, that tale has changed quite a bit from laboring generation to generation (fortunately for the better). In the early days, enduring labor — from the first sharp twinge to the last grueling push — was the only option. Then came the anesthetic revolution, which offered an attractive alternative — go to sleep, wake up with a baby. Of course, there was only one little problem with this method: The woman missed the entire experience.

Thankfully these days a number of safe and effective medical options can take some of the labor out of labor and delivery. It is possible to create a birth plan that ensures little or no pain — while you remain awake during the entire process and are able to greet your newborn as he or she emerges. Here are a few of the top medications to manage labor pain so you can have your birth, your way.

Anesthetics

Anesthetics, substances that cause partial or complete loss of sensation, have long been the most common pain relief for labor and delivery. Here are the options.

General and Regional Anesthesia

What it is: General anesthesia is rarely used for delivery these days and is only used in specific cases for emergency surgical births. It quickly puts the entire body (and mind, of course) completely to sleep. It’s the same stuff you’d get if you were having open heart surgery or a kidney removed.

How it’s administered: It’s usually inhaled, although it’s sometimes delivered intravenously (or a combination of both).

When it’s used: Though it’s extremely safe, it is as extreme as it sounds — which is why it isn’t used today for childbirth unless an emergency cesarean is required and there’s no time to give a regional anesthetic (like a spinal block). It can also be required in a difficult vaginal breech birth, to deliver the baby’s head.

How it makes you feel: Expect to be totally knocked out for the entire birth (usually a matter of minutes). You’ll wake up groggy, disoriented, perhaps restless, and with a sore throat from the endotracheal tube (used to ensure that you don’t breathe the contents of your stomach into your lungs). You’ll also probably be rather queasy and may vomit, and you’ll have sluggish bowels and bladder. The effects vary from person to person.

Just as you’re sedated temporarily, your baby will be too (temporarily). To reduce the effect, the anesthesiologist will try to put you out very close to your actual delivery, reducing the amount of drugs that get through your system and into the baby. The doctor might also tilt you to your side or give you oxygen to get more oxygen to your baby, minimizing the drug’s temporary effect.

What it is: This anesthetic is injected directly into the spine, so it bypasses the bloodstream — making it safer for your baby. It’s the pain relief of choice for half of all laboring women delivering (both vaginal and cesarean) at hospitals.

How it’s administered: An anesthesiologist inserts a thin catheter into your back to deliver the anesthetics. It could take 15 minutes (or longer) for them to kick in, but they can be given to you as soon as you ask — no need to wait until you’re dilated a certain amount. You’ll also have a catheter inserted into your urethra (the procedure causes you to lose lower body sensation, so you’ll have no idea when you need to pee).

How it makes you feel: Once the epidural starts working, your entire lower body will feel numb, including the nerves of your uterus — so you won’t feel the pain of contractions (you’ll note the tensing of your uterus and some pressure). Some women have trouble pushing on an epidural; others report no trouble. Afterward, you might feel cold, experience numbness on one side of your body, and you’ll be a bit rubbery-legged. Unlike with general anesthesia, your baby won’t be affected by an epidural.

The combined spinal epidural: Another epidural option is the combined spinal epidural, although it’s available only in some hospitals. Because of where the anesthetic is injected, you can still feel and use the muscles in your legs (which is why it’s also called a walking epidural). When you feel you need more pain relief, you can get more medication via the catheter that was inserted at the same time the spinal medication was administered.

Learn lots more about epidurals here.

Pudendal Block

What it is: Occasionally used to relieve early second-stage labor pain, a pudendal block is usually reserved for the vaginal delivery itself. It’s useful when forceps or vacuum vaginal extraction is used.

How it’s administered: The anesthetic is injected through a needle inserted into the perineal or vaginal area.

How it makes you feel: It reduces pain in the injection area but not uterine discomfort – so you’ll still feel the full force of your contractions.

Spinal Block or Saddle Block

What it is: These regional blocks, which are rarely used for vaginal birth these days, are generally administered in a single dose just prior to delivery (in other words, if you didn’t have an epidural during labor but want pain relief for the delivery, you’ll get the fast-acting spinal block). The spinal block is often used for cesarean delivery, while the saddle block is for instrument-assisted vaginal delivery.

How it’s administered: Like an epidural, these blocks are administered with you sitting up or lying on your side while an anesthetic is injected into the fluid around the spinal cord.

How it makes you feel: As with an epidural, you’ll be numb and may experience a drop in blood pressure and feel queasy afterward. With a spinal, you’ll have to stay flat on your back for about eight hours after delivery.

Pain-Relieving Drugs (Analgesics)

If you don't want an anesthetic, you can opt for pain-relieving drugs (analgesics) that lessen the pain (or make you care a little less that you have it). A shot in the buttocks is most common, but it may be administered with an IV. Here are the most common options.

Demerol

What it is: A drug (meperidine hydrochloride) that’s not just for vaginal labor and delivery, but also C-sections, episiotomy repair, and the removal of the placenta. It can be repeated every two to four hours, and it won’t interfere with your contractions (although larger doses can make them less frequent and less intense; some women are given Demerol to get their contractions into a more normal rhythm).

How it’s administered: You won’t be given Demerol far in advance of delivery or if there’s a chance you're in false labor; two to three hours before the estimated time of birth is the usual rule.

How it makes you feel: Drugs affect everyone differently, and Demerol is no exception. You might not like the dopey, drowsy feeling you get (and the nausea and vomiting some women experience); or you might feel helpfully relaxed. Because it enters your bloodstream, your baby will feel some effects (the intensity will depend on how close to delivery you receive the drug). Baby's heart rate might drop, and he or she may be sleepy and temporarily unable to nurse. Some babies have to be given oxygen, although all the effects are short-lived and treatable.

Tranquilizers

What it is: If you’re extremely nervous or anxious, you might need a tranquilizer (Phenergan or Vistaril are common) to get through labor and delivery — especially if their anxiety is stopping the progression of labor. Tranquilizers also make Demerol and other analgesics more effective.

How it’s administered: You’ll usually only receive a shot of tranquilizer once labor is well-established, and well before delivery (though they are occasionally used if anxiety is slowing down the progress of labor).

How it makes you feel: As with analgesics, the effects will vary from person to person — and, of course, depend upon dosage. Low doses might make you pleasantly drowsy; high doses could cause you to drop off to sleep between contractions (probably not a good idea). Although the risks to baby are minimal, most practitioners prefer to stay away from tranquilizers unless they’re really necessary.

Drug–Free Pain Relief

If you’re not sure whether traditional medicated childbirth pain relief is for you, you might want to try for a more natural childbirth and rely on complementary and alternative (CAM) techniques that distract you from the pain of labor. You can choose to go un-medicated throughout your labor, or you can decide that a combination of traditional and CAM techniques that work best for you. Explore your options, talk to your practitioner, and keep in mind that you don't just have to pick just one.

The material on this website is provided for educational purposes only and is not to be used for medical advice, diagnosis, or treatment, or in place of therapy or medical care. Use of this site is subject to our terms of use and privacy policy

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